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Teaching Diagnosis
What Do People Need to Learn?

By Roger C. Schank / February 2010

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Teaching Diagnosis

What Do People Need to Learn?

Roger C. Schank

February 23, 2010

What do people need to learn?

Every curriculum committee and every training organization has at one time or another convened a committee to answer this question. Their answers are always given in terms of subjects: "more math," "telecommunication," "risk management," "company policies." But subject matter is far less important in learning than you think. It is in what underlies the subject matter where you will find what really needs to be learned.

Consider medicine. What should a doctor learn? Doctors take courses in anatomy and immunology and so on, and certainly we want any doctor who treats us to know about these things. But what skill do we want doctors to have above all? We want them to make a proper diagnosis of our problem.

Now consider car mechanics. We want them to understand how an engine works and such. But what do we want them to know more than anything? We want mechanics to make a proper diagnosis of our problem.

The same is true of business consultants, architects, financial planners, and most other professionals. We want people who can do diagnosis.

But, when do we teach diagnosis? Typically we teach it within the confines of a particular subject, way at the end, after all the subject matter has been learned. This is exactly backward.

Diagnostic Learning
Think about it this way. What is harder to learn: proper diagnosis of an illness or the names and functions of all the body parts? Most anyone can learn body parts, but diagnosis is a seriously important skill. You would never choose doctors based on their ability to name the body parts quickly.

But, if diagnosis is difficult to learn, the implication is that one needs a lot of practice doing it. And if it's important to learn, the implication is that one ought to be practicing it very early on in life.

Or to put this another way, when you are designing an e-learning course and you are told to teach a particular subject matter, you need to translate that request into one about diagnosis, if at all possible.

Other critical skills include determining causation, making predictions, and making plans. These are, of course, often key parts of the diagnostic process.

How should we teach these skills?

People learn diagnosis by doing diagnosis. This means that any good course would start with a diagnostic problem and would continually increase the complexity of that problem. For example, Sally's lemonade stand is failing; determine why. Concepts of profit and loss can be taught within the attempt to diagnose. Subject matter is important, but it is secondary to, and dependent upon, the need for it within the diagnostic process.

Thinking and Learning
When we assess someone's intelligence we can forgive lack of subject matter knowledge much more easily than we can forgive lack of diagnostic ability. Let's examine a quote from a Sarah Palin supporter responding to a question about Palin's foreign policy:

"I don't know much about her foreign policy but the state that she did govern was right across the street from Russia. You know so I'm not saying that she ever had to deal with Russia but I'm sure she had boundaries issues she had to deal with. We have boundary issues right now with Mexico now."

Clearly, this person has no ability to make an effective diagnosis. He does not understand causation either. In short, he seems stupid not because he doesn't know about Palin's foreign policy, but because he has diagnosed "illegal immigration" as something one would certainly be an expert on if one had governed Alaska.

Another way of putting this is to make the assumption that no one has ever taught this man how to break down an issue and examine its causation, nor has he learned how to make a prediction. We can assume he has studied geography and perhaps taken a course that covered the political process. It is thinking he is deficient at.

How might we teach him to think more clearly? We would need to present him with a problem and have him diagnosis its causes and plan a solution, but we would need to start more simply than foreign policy. We might start with examining "boundary issues" in his own neighborhood for example.

Technology and Learning Diagnostics
How can technology play a role in teaching diagnosis and in teaching thinking in general? Or, to put it another way, why is it that courses rarely work the way I am suggesting, with diagnostic issue first, and facts and theories later?

When you teach a course in a classroom, it's not so easy to start with a diagnostic problem. Such problems require real thought, hard work, recovery from errant hypotheses, and Socratic mentoring focused on creating new ways of looking at a problem. In other words teaching diagnosis is facilitated by one-on-one interactions between teacher and student. We can do this easily online or at home with our children, but it is very hard to do in the classroom.

One value of technology is it enables one-on-one teaching in a world where people can no longer afford personal tutors. And of course, we can set up physical situations virtually. These situations can be richly elaborated and allow for exploration and discovery. It's much better to diagnose a virtual patient, or a business or an electrical problem, than a real one.

So, what should we teach?

Diagnosis, planning, prediction, causation and similar cognitive processes.

How should we teach those skills? Through simulations and one on one mentoring, starting with a problem to be fixed before any facts or theory have been presented.

What is the role of technology? Technology's role is to support this learning and teaching in a cost effective way.

e-Learning as the Vehicle for Change
E-learning is the vehicle for change that our education system needs. We need to stop building courses that replicate courses offered in classrooms and begin to capitalize upon what we know about cognition and what we know about learning to offer courses that are differently focused. This means starting with what matters in learning—learning how to think, and what matters in teaching—helping students to be able to reason things out on their own.

About the Author
Roger C. Schank is one of the world's leading researchers in AI, learning theory, cognitive science, and the building of virtual learning environments. He is president and CEO of Socratic Arts, a company whose goal is to design and implement low-cost story-based learning by doing curricula in schools, universities, and corporations.


  • Tue, 03 Aug 2010
    Post by werner

    Hi all!

    What I was looking for. Thank you.

  • Sun, 23 May 2010
    Post by Jeff Hammond

    Mr. Schank-thank you so much for these insights. I am just beginning an on-line graduate program in instructional design, and what you've articulated really hits home. For example, my initial observations (and frustrations) of the e-learning I've experienced (not with my ID program, mind you!), is that the learner tends to play second fiddle to the instruction, and most of the intended on-line content ends up going in one ear and out the same one in a very short amount of time. The concept of teaching diagnosis has really inspired me, and really raises the bar for me in terms of my teaching, as well as what I would expect from any ID program. I'm barely into my program, and I don't yet know enough to work it into whatever ID programs I eventually end up being a part of, but I am bookmarking this page, and suggesting this article to my fellow classmates. Our next module is on front-end analysis, and this article dovetails in beautifully with our coursework.

  • Tue, 23 Feb 2010
    Post by Jason West

    Great are mired in huge amounts of detail, that is then tested in a standardised, fact-oriented way...many students I come into contact with have no idea how to problem solve or think for themselves. Our course works incredibly well but initially we need to educate learners about the way it works and how they need to follow the process. My gut feeling is that technology is going to serve youngest students better than it has the generation before that. Facts are easy to find now, using and applying them is the skill whereas 10-20 years ago education policy was still trying to teach and test facts. There's a movement/website/CD called 'We are the people we've been waiting for' launched by David Puttnam and others (film producer and all round mogul) that shows how our current education systems are failing our students because we are still trying to teach and test stuff that is that their fingertips...time is being used in the most astonishingly wasteful way.